Although much progress has been made to develop effective new cancer therapeutics, surgery remains the foundation of cancer treatment for either complete resection of primary lesions or for debulking (or cytoreductive surgery) that enables more efficacious radiation and/or chemotherapy. Residual tumor burden after surgery is strongly correlated with reduced survivor rates. When possible, wide-field surgical excision can reduce the chance of positive tumor margins and residual disease, although it can also lead to disfigurement and enhanced risk for surgical morbidities. Despite the crucial role that surgery plays in outcomes, tissue resection is predominantly guided through visual cues that can be augmented by tactile cues in the setting of open surgery. With the increasing use of robotic, laproscopic, and/or endoscopic surgeries, tactile cues become limited.
Fluorescence imaging with molecularly targeted agents provides the “low hanging fruit” of molecular medicine by adding molecular diagnostics and potentially improving surgery by reducing the amount of residual disease left behind. Fluorescence molecular imaging involves the administration of a targeted-agent labeled with a fluorophore. While the development of fluorescence imaging agents is the subject of several academic laboratories, there remains a need for instrumentation that can sensitively detect the fluorescence associated with disease markers that demarks disease at pM-fM tissue concentrations. In the operating room, backscattered excitation light and ambient room light can “leak” through filters and reduce the contrast that is necessary for visual delineation of tumor boundaries. In current practice, using laproscopic and endoscopic surgical tools, fluorescence imaging concurrent with white light illumination of the surgical field is necessary for fluorescence molecularly guided resection, yet the white light illumination of current laproscopic/endoscopic devices causes “leakage” through filters also reducing contrast. In order to achieve molecularly guided surgery, procedures should be conducted simultaneously with diagnostic imaging to be effective.